Rheumatic fever recurrence: Risk factors and clinical characteristics

Background

Rheumatic fever recurrence (RFrec) contributes to the worsening of rheumatic valve disease. There are few studies describing the factors associated with recurrence.

Objectives

To analyze the potential risk factors for RFrec in an outpatient cohort.

Methods

We evaluated 148 patients from a cohort of 218 patients treated at rheumatic fever (RF) clinics of the University Hospital Prof. Edgard Santos (Salvador-BA), with at least two years of follow-up.

Results

The mean age was 29.7 ± 12.7 years, with 64% female. RFrec occurred in 14.2% of patients. Patients with and without recurrence differed in age (23.4 ± 9.9 × 30.8 ± 12.7 years, p = 0.024), age ≤ 23 years (82.3% vs 39.6%, p = 0.001), non-adherence to prophylaxis (36.8% vs 15.5%, p = 0.027), prior heart failure (HF) (38% vs. 17%, p = 0.03), presence of aortic regurgitation on echocardiography (71% vs. 44%, p = 0.05) and diastolic dimension of the left ventricle (58.0 ± 16.2 × 51.6 ± 8.6 mm, p = 0.025). Estimated relative risk of RFrec were: age ≤ 23 years RR 5.6 (95% CI 1.7 to 18.5) — p = 0.001; non-adherence to prophylaxis RR 2.6 (95% CI 1.1 to 5.9) — p = 0.027; prior HF RR 2.4 (95% CI 1.1 to 5.2) — p = 0.03. In multivariate analysis, these three parameters showed significant independent association with RFrec.

Conclusions

RFrec occurred in 14.2% of patients. Age ≤ 23 years, lack of adherence to secondary prophylaxis and prior HF were independent predictors of recurrence.